Javed Kainaat, Boyke Andre, Naidu Ishan, Ryvlin Jessica, Fluss Rose, Fortunel Adisson N, Dardick Joseph, Kadaba Devikarani, Altschul David J, Haranhalli Neil
Neurological Surgery, Montefiore Medical Center, New York, USA.
Neurological Surgery, John Hopkins University, Baltimore, USA.
Cureus. 2022 Apr 24;14(4):e24449. doi: 10.7759/cureus.24449. eCollection 2022 Apr.
Background Endovascular therapy is known to achieve a high rate of recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and is currently the standard of care. Hemorrhagic conversion is a severe complication that may occur following AIS in patients undergoing endovascular thrombectomy (EVT). There is a scarcity of data on the risk factors related to HV in post-EVT patients, especially those who develop symptomatic hemorrhagic conversion. The main objective of our study is to identify independent predictors of radiographic and symptomatic hemorrhagic conversion in our diverse patient population with multiple baseline comorbidities that presented with AIS and were treated with EVT as per the most updated guidelines and practices. Methodology This is a retrospective chart review in which we enrolled adult patients treated with EVT for AIS at a comprehensive stroke center in the Bronx, NY, over a four-year period. Bivariate analyses followed by multiple logistic regression modeling were performed to determine the independent predictors of all and symptomatic hemorrhagic conversion. Results A total of 326 patients who underwent EVT for AIS were enrolled. Of these, 74 (22.7%) had an HC, while 252 (77.3%) did not. In total, 25 out of the 74 (33.7%) patients were symptomatic. In the logistic regression model, a history of prior ischemic stroke (odds ratio (OR) = 2.197; 95% confidence interval (CI) = 1.062-4.545; p-value = 0.034), Alberta Stroke Program Early CT Score (ASPECTS) of <6 (OR = 2.207; 95% CI = 1.477-7.194; p-value = 0.019), and Thrombolysis in Cerebral Infarction (TICI) 2B-3 recanalization (OR = 2.551; 95% CI = 1.998-6.520; p-value=0.045) were found to be independent predictors of all types of hemorrhagic conversion. The only independent predictor of symptomatic hemorrhagic conversion on multiple logistic regression modeling was an elevated international normalized ratio (INR) (OR = 11.051; 95% CI = 1.866-65.440; p-value = 0.008). Conclusions History of prior ischemic stroke, low ASPECTS score, and TICI 2B-3 recanalization are independent predictors of hemorrhagic conversion while an elevated INR is the only independent predictor of symptomatic hemorrhagic conversion in post-thrombectomy patients.
背景 已知血管内治疗可使因大血管闭塞（LVO）导致的急性缺血性卒中（AIS）患者实现较高的再通率，目前是标准治疗方法。出血性转化是接受血管内血栓切除术（EVT）的AIS患者可能发生的严重并发症。关于EVT术后患者出血性转化相关危险因素的数据稀缺，尤其是那些发生症状性出血性转化的患者。我们研究的主要目的是在我们多样化的患者群体中确定影像学和症状性出血性转化的独立预测因素，这些患者有多种基线合并症，表现为AIS，并按照最新指南和实践接受了EVT治疗。
方法 这是一项回顾性病历审查，我们纳入了纽约布朗克斯区一家综合卒中中心在四年期间接受EVT治疗AIS的成年患者。进行双变量分析，然后进行多因素逻辑回归建模，以确定所有类型和症状性出血性转化的独立预测因素。
结果 共有326例接受AIS的EVT治疗的患者被纳入。其中，74例（22.7%）发生了出血性转化，而252例（77.3%）未发生。在74例患者中，共有25例（33.7%）出现症状。在逻辑回归模型中，既往缺血性卒中史（优势比（OR）=2.197；95%置信区间（CI）=1.062 - 4.545；p值=0.034）、阿尔伯塔卒中项目早期CT评分（ASPECTS）<6（OR = 2.207；95%CI = 1.477 - 7.194；p值=0.019）以及脑梗死溶栓（TICI）2B - 3级再通（OR = 2.551；95%CI = 1.998 - 6.520；p值=0.045）被发现是所有类型出血性转化的独立预测因素。多因素逻辑回归建模中症状性出血性转化的唯一独立预测因素是国际标准化比值（INR）升高（OR = 11.051；95%CI = 1.866 - 65.440；p值=0.008）。
结论 既往缺血性卒中史、低ASPECTS评分和TICI 2B - 3级再通是出血性转化的独立预测因素，而INR升高是血栓切除术后患者症状性出血性转化的唯一独立预测因素。
